Dealing With Disorders

Anorexia has the highest premature mortality rate of any psychiatric disorder, with most deaths attributable to physiological complications. Yet, says Dr. Elizabeth Esalen, there is still a dangerously misguided public perception of eating disorders.

“I think there’s an odd sort of glorification around eating disorders,” says Esalen, a clinical psychologist and the founder of The Lotus Collaborative, a local eating disorder treatment center. “As a society, we haven’t really caught up. People sort of glorify anorexia, and completely ignore other forms of eating disorders.”

Thirteen million Americans binge eat, and another 10 million women (and one million men) struggle with anorexia or bulimia, according to the National Eating Disorder Association. Additionally, hospitalization for eating disorders rose 18 percent between 1999 and 2006.

American medical insurance providers only began to unilaterally allow those with eating disorders to use their coverage for long-term care and recovery as recently as last year, due to an August 2011 ruling by the United States Court of Appeals. Esalen says that lack of access to reliable medical and psychological care for the millions of Americans who suffer from eating disorders has been especially harmful.

“Catching the illness as soon as possible is really important,” says Esalen. “If you don’t catch it quickly, the chances of it becoming lifelong rise sharply. And if you don’t have health insurance, your options are really limited.”

The Lotus Collaborative, which operates out of a cozy two-story townhouse on Mission Street, was the first intensive outpatient and partial hospitalization center for eating disorders in Santa Cruz and Monterey counties. Esalen founded the center—which will celebrate its one-year anniversary on Friday, Nov. 9—to provide a level of help that falls between the already available options of complete hospitalization and group therapy.

“People come in during the day for anywhere from seven to four hours a day,” says Esalen. “It’s flexible.”

The Lotus Collaborative takes a holistic approach toward treatment; there are patients who undergo intensively structured visits with snack therapy and group counseling, and others who work with the center to structure treatment around their daily lives.

“When you look at eating disorders, it’s not really about food or weight,” says Esalen. “It’s really about a need for control, a need for identity or power. As we start working with people, you see the mental need for the disorder decrease.”

Elizabeth Hyde, a nurse practitioner and the patient care coordinator at the UC Santa Cruz health center, adds that eating disorders are often difficult for the sufferer to address on his or her own.

“One of the things that characterizes anorexia is that the individual has an inaccurate understanding of their own body image; their ability to respond has been skewed,” says Hyde. “Anorexia is characterized by ambivalence.”

Hyde says that there are two groups in Santa Cruz, in particular, that struggle with eating disorders. The first is students, whom she works with.

“California, in particular, gives young people huge messages about what their bodies should look like,” says Hyde. “And it’s hard to come into the office and tell a stranger that you make yourself throw up. It’s a vicious cycle of isolation that exacerbates the issue.”

Esalen agrees that college students are especially vulnerable.

“College is a really transitional period, where you’re going from being really dependent on your parents to exploring your identity,” she says. “If there are already issues surrounding food, they are going to be escalated.”

The second group is a demographic less bound by a common age: those battling orthorexia, which Esalen says is increasingly common in Santa Cruz. Orthorexia is defined as an unhealthy obsession with eating healthily.

“You can only sustain the impact of orthorexia for so long,” says Esalen. “There’s a definite spike in people who don’t even self-identify as having an eating disorder. A lot of the time you can’t even tell if someone is struggling. It’s not as superficial as that. There’s this positive reinforcement that comes with depriving oneself—it’s devastating, and it’s reckless.”

The American dieting industry is worth $40 billion dollars, and, with those kinds of numbers, Esalen doesn’t think that trends in orthorexia, binge eating and extreme dieting will slow down anytime soon.

“A lot of people can get really obsessed with a certain diet approach,” says Esalen. “Most of them aren’t bad, per se, but when they become the priority and your diet becomes a religion, you’re no longer in control.”

With that in mind, she says it is more important than ever for Americans of all ages and backgrounds to make a concerted effort to understand the finer details of eating disorders and the tribulations faced by those suffering from them.

“Because I used to work in Los Angeles, I used to get asked a lot about whether [Californian culture was] especially hard on people with eating disorders,” says Esalen. “The truth is, eating disorders are an issue no matter where you are. There’s a high correlation between eating disorders and trauma, so you’re going to find it everywhere.”